Workers’ Comp Medical Benefits

Medical Benefits:

If injured in the scope of your employment, you are entitled to 100% coverage of your reasonable and necessary medical care, related to your on-the-job injury, without co-pays or limits, until you reach maximum medical improvement (MMI).

If you are determined to be Permanently Totally Disabled, medical care continues.

Authorized Treating Physician ( ATP ):

Other than initial emergency care received before your employer and its insurance carrier can become involved, your medical care under a workers’ compensation claim will be performed by “authorized treating physicians”.

Initially, your employer has the right to choose your ATP when it learns of your injury. Most large employers and insurance carriers regularly use your favorite medical clinic to evaluate your medical condition. If your ATP refers you on to another medical provider, the new provider is also an ATP.

There is a procedure by which you may request a one-time change to a different ATP, within 45 days of the injury.

Authorized Treatment:

Even though it is recommended by your ATP, at times the employer/carrier will deny a request by the ATP to perform certain treatment. The denial may be based upon any of a number of objections, such as that the treatment is not necessary, is a new experimental type procedure, etc. In this case, the denial is usually backed up by some additional opinion obtained by the employer/carrier. If the issue cannot be resolved by providing additional documentation to support the proposed treatment, the controversy may need to be decided by a judge at a hearing on the matter.

Ongoing Medical Care:

Eventually, most workers’ compensation claims close when the injured worker has reached “maximum medical improvement”. However, it may be possible to received future medical benefits at the expense of the employer, if they are clearly specified by the ATP at the time of the case closure. If there appears to be a need for such ongoing benefits, it is very important to ensure that they are specified in the legal documents closing the case.

We provide representation serving the entire south Denver, Colorado (CO) Metropolitan area, including Littleton, Englewood, Centennial & Aurora in Arapahoe County, Highlands Ranch and Castle Rock in Douglas County, Denver and south Jefferson County, Colorado. Evening and weekend appointments are available upon request.